Question 1

Which statement below describes a medically necessary service?  A. Performing a procedure/service based on cost to eliminate wasteful services. B. Using the least radical service/procedure that allows for effective treatment of the patient\'s complaint or condition. C. Using the closest facility to perform a service or procedure. D. Using the appropriate course of treatment to fit within the patient\'s lifestyle.

Accepted Answer

B. Using the least radical service/procedure that allows for effective treatment of the patient\'s complaint or condition.  Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient\'s complaint or condition.

Question 2

According to the example LCD from Novitas Solutions, measurement of vitamin D levels is indicated for patients with condition?  A. fatigue B. fibromyalgia C. hypertension D. muscle weakness

Accepted Answer

C. hypertension  Rationale: According to the LCD, measurement of vitamin D levels is indicated for patients with fibromyalgia.

Question 3

What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges?  A. LCD B. CMS-1500 C. UB-04 D. ABN

Accepted Answer

D. ABN  Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient.

Question 4

Select the true statement regarding ABNs.  A. ABNs may not be recognized by non-Medicare payers. B. ABNs must be signed for emergency or urgent care. C. ABNs are not required to include an estimate cost for the service. D. ABNs should be routinely signed by Medicare beneficiaries in case Medicare does not cover a service.

Accepted Answer

A. ABNs may not be recognized by non-Medicare payers.  Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered.

Question 5

When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost?  A. $25 or 10% B. $100 or 10% C. $100 or 25% D. An exact amount.

Accepted Answer

C. $100 or 25%  \"Notifiers must make a good faith effort to insert a reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.\"  Rationale: CMS instructions stipulate, \"Notifiers must make a good faith effort to insert a reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.\"

Question 6

Who would NOT be considered a covered entity under HIPAA?  A. Doctors B. HMOs C. Clearinghouse D. Patient

Accepted Answer

D. Patient  Rationale: Covered entities in relation to HIPAA include healthcare providers, health plans, and healthcare clearinghouses. The patient is not considered a covered entity although it is the patient\'s data that is protected.

Question 7

Under HIPAA, what would be a policy requirement for \"Minimum Necessary?\"  A. Only individuals whose job requires it may have access to protected health information. B. Only the patient has access to protected health information. C. Only the treatment physician has access to protected health information. D. Anyone within the provider\'s office can have access to protected health information.

Accepted Answer

A. Only individuals whose job requires it may have access to protected health information.  Rationale: It is the responsibility of a covered entity to develop and implement policies best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information.

Question 8

Which Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security?  A. HIPAA B. HITECH C. SSA D. FECA

Accepted Answer

B. HITECH  Rationale: The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted as a part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology. Portions of HITECH strengthen HIPAA rules by addressing privacy and security concerns associated with the electronic transmission of health information.

Question 9

What document has been created to assist physician offices with the development of compliance manuals?  A. OIG Compliance Plan Guidance B. OIG Work Plan C. OIG Suggested Rules and Regulations D. OIG Internal Compliance Plan

Accepted Answer

A. OIG Compliance Plan Guidance  Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still active compliance guidance today.

Question 10

What document should be referred to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?  A. OIG Compliance Plan Guidance B. OIG Work Plan C. OIG Security Summary D. OIG Document Planner

Accepted Answer

B. OIG Work Plan  Rationale: Each October, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.

Question 11

____ is a term standing for enlargement of the heart.

Accepted Answer

A. Cardiomegaly  Response Feedback: Rationale: Cardio = heart, megaly = enlargement

Question 12

A patient suffering from an abdominal aortic aneurysm involving a renal artery undergoes endovascular repair deploying a fenestrated visceral autograft using two visceral artery endoprostheses. Radiological supervision and interpretation was performed. Select the CPTÂ® code(s) for this procedure.

Accepted Answer

D. 34842  Rationale: Look in the CPTÂ® Index for Repair/Aorta/Visceral/Endovascular directing you to code 34841-34848. Code 34842 is correct to report because two visceral artery endoprostheses were used.

Question 13

What is the term for the divider between the heart chamber walls?

Accepted Answer

D. Septum  Rationale: The heart is divided into right and left sides by a septum, which is a muscular wall.

Question 14

How many layers of tissue does an artery have?  A. Three B. Two C. Four D. One

Accepted Answer

A. Three  Rationale: An artery has three layers: an outer layer of tissue, a muscular middle, and an inner layer of epithelial cells.

Question 15

The conduction system contains pacemaker cells, nodes, the ____, and the ____.

Accepted Answer

A. Purkinje fibers and Bundle of His  Rationale: The conduction system contains pacemaker cells, nodes, the bundle of His, and the Purkinje fibers.

Question 16

Patient is diagnosed with acute systolic heart failure due to hypertension with CKD stage 4.

Accepted Answer

C. I13.0, I50.21, N18.4  Rationale: There is a causal connection with hypertension and heart failure, and one is assumed with CKD, so a combined code I13.0 is needed. The type of heart failure and stage of CKD are also needed to complete the coding. In the Alphabetic Index look for Hypertension/cardiorenal (disease)/with heart failure/with stage 1 through stage 4 chronic kidney disease I13.0. In the Tabular List there is a note below I13.0 to Use additional code to identify the type of heart failure. Look for Failure/heart/systolic (congestive)/acute referring you to I50.21. Instructions further indicate to also code for the stage 4 of chronic kidney, reporting N18.4.

Question 17

Due to infections from hemodialysis, the physician replaces a dual chamber implantable defibrillator system with a multi-lead system with an epicardial lead and transvenous dual chamber lead defibrillator system. The original dual leads are extracted transvenously. The generator pocket is relocated.

Accepted Answer

B. 33244, 33202-51, 33264-51, 33223-59  Rationale: When a new system is placed after removal of an old system, report the codes for removal of the components and insertion of the new system. The removal of the dual chamber implantable defibrillator electrodes is reported with 33244. Look in the CPTÂ® Index for Implantable Defibrillator/Removal/Electrodes 33238, 33243, 33244, 33272. The insertion of the epicardial electrode is reported with 33202. In the CPTÂ® Index look for Insertion/Electrode/Heart 33202-33203. The dual defibrillator generator was replaced with a multi-lead defibrillator generator 33264. Look in the CPT Â® Index for Implantable Defibrillator/Replacement/Pulse Generator 33224, 33262-33264. Code 33264 describes the removal and replacement of an implantable defibrillator pulse generator. Two leads were replaced. Look in the CPTÂ® Index for Implantable Defibrillator/Insertion/Electrodes 33202, 33203, 33216, 33217, 33224, 33225, 33271. Code 33217 describes the insertion of two transvenous electrodes for an implantable defibrillator; however, the notes under 33264 tell you not to report 33217. Code 33217 is bundled with 33264. The notes for this section of CPT tell you to use 33223 for the relocation of the skin pocket for clinical situations such as infection. Modifier 51 is needed on 33202 and 33264. Modifier 59 is needed on 33223 to show that it is separate from 33244.

Question 18

Aortography and bilateral extremity angiography were performed. The physician placed the catheter in the aorta at the level of the renal arteries and injected contrast for the aortography and repositioned the catheter just above the bifurcation for angiography of the lower extremities.

Accepted Answer

D. 36200, 75625-26, 75716-26  Rationale: Because the catheter was repositioned, and separate studies were performed, both the aortography and the extremity angiography are reported. Look in the CPTÂ® Index for Catheterization/Aorta for 36160-36200. In the Index, see Aorta/Aortography, and you are referred to 75600-75630. Angiography of the lower extremities is found under Angiography/Leg Artery, referring you to 73706, 75635, 75710-75716. Modifier 26 reports the professional service.

Question 19

In the cath lab, a physician places a catheter in the aortic arch from a right femoral artery puncture to perform an angiography. Fluoroscopic imaging is performed by the physician.

Accepted Answer

A. 36221  Rationale: The aorta is the trunk of the system, so it is a non-selective catheterization. Only one code is reported for the catheterization and fluoroscopic imaging, code 36221. This is found in the CPTÂ® Index under Angiography/Cervicocerebral Arch.

Question 20

A patient presents to the outpatient surgery department for revision to his autogenous radiocephalic fistula so he can continue his hemodialysis. The correct CPTÂ® code is:

Accepted Answer

A. 36832  Rationale: The patient is undergoing revision of the arteriovenous (radiocephalic) fistula. The CPTÂ® code is indexed under Arteriovenous Fistula/Revision/without Thrombectomy referring you to code 36832.

Question 21

A physician performs a four-vessel autogenous (one venous, three arterial) coronary bypass on a patient who had a previous CABG two years ago, utilizing the saphenous vein, radial artery and the left and right internal mammary arteries. Select the CPTÂ® codes for this procedure.  A. 33535, 33517, 33530, 35600  C. 33535, 33510-51, 33530, 35600

Accepted Answer

A. 33535, 33517, 33530, 35600  Rationale: Because this is a combo graft, codes 33517-33523 must be coded for the venous portion of the graft. Also, this is a redo more than one month after the original surgery, so the add-on code 33530 is appropriate. This is found in the CPTÂ® Index under Coronary Artery Bypass Graft (CABG)/Arterial-Venous Bypass 33517-33523, and Arterial Bypass 33533-33536. Also listed under this section in the Index is Reoperation 33530. In this same section under CABG is Harvest/Upper Extremity Artery 35600. Look up the codes in the procedure listing, and you see all additional codes are add-on codes; therefore, no modifiers are required.

Question 22

A patient presents to the hospital for a cardiovascular SPECT study. A single study is performed under stress, but without quantification, with a wall motion study, and ejection fraction. Select the CPTÂ® code(s) for this procedure.  A. 78451  D. 78453

Accepted Answer

A. 78451  Rationale: Code 78451 indicates a perfusion study either qualitative or quantitative. There is no mention of cardiac blood pooling imaging which eliminates choices a. and b. Code 78453 reports a planar study, and this was a SPECT study, thus eliminating c. This is found in the CPTÂ® Index under Nuclear Medicine/Diagnostic/Heart/Myocardial Perfusion Imaging or SPECT/Heart/Single.

Question 23

What information is needed in order to accurately code hypertension retinopathy in ICD-10-CM?

Accepted Answer

D. The affected eye(s).  Rationale: Hypertensive retinopathy for ICD-10-CM needs a sixth character that specifies the laterality of the retinopathy. Look in the Index to Diseases and Injuries for Retinopathy/hypertensive H35.03.

Question 24

Select the ICD-10-CM diagnosis codes used for pseudoaneurysm, cardiac tamponade and left ventricular failure.

Accepted Answer

D. I72.9, I31.4, I50.1  Rationale: In the ICD-10-CM Alphabetic Index, look for Pseudoaneurysm directs the user to see Aneurysm. The subterm pseudoaneurysm is not listed; therefore, the unspecified code I72.9 is correct. In the Index to Diseases, look for Tamponade, heart referring you to I31.4. Next look for Failure/ventricular/left, I50.1. Always verify your codes in the Tabular List.

Question 25

In the hospital setting a patient undergoes transcatheter placement of an extracranial vertebral artery stent in the right vertebral artery. Which CPTÂ® code is reported by the physician providing only the radiologic supervision and interpretation?  A. 0075T-26 B. 0075T

Accepted Answer

A. 0075T-26  Rationale: This is a Category III code. Look in the CPTÂ® Index under Stent/Placement/Transcatheter/Intravascular/Extracranial, and you are referred to 0075T-0076T. When you check these codes, you see S&I is included; therefore, modifier 26 reports the professional service.

Question 26

What is included in all vascular injection procedures?

Accepted Answer

A. Necessary local anesthesia, introduction of needles or catheters, injection of contrast media with or without automatic power injection, and/or necessary pre-and post-injection care specifically related to the injection procedure.  Rationale: CPTÂ® guidelines under Vascular Injection Procedures indicate the above-listed in d as being included.

Question 27

Patient undergoes a mitral valve repair with a ring insertion and an aortic valve replacement, on cardiopulmonary bypass.

Accepted Answer

D. 33426, 33405-51  Rationale: 33426 reports mitral valve valvuloplasty with a prosthetic ring, and 33405 reports an aortic valve replacement with cardiopulmonary bypass. Modifier 51 is required on the second procedure to indicate multiple procedures performed during the same setting. Look in the CPTÂ® Index for Valvuloplasty/Mitral Valve, you are referred to 33425-33427. You can find the aortic valve replacement in the Index under Replacement/Aortic Valve. You must examine the range of codes given for this procedure.

Question 28

A patient presents for extremity venous study. Complete noninvasive physiologic studies of both lower extremities were performed.

Accepted Answer

A. 93965  Rationale: Code 93965 reports a complete bilateral noninvasive physiologic study of extremity veins. This study can be found in the CPTÂ® Index by referencing Vascular Studies/Venous Studies/ Extremity 93965-93971. Modifier 50 is not appended because the term bilateral is included in the code description for 93965.

Question 29

The cardiologist advances a 6 French catheter into the left renal artery via a right common femoral puncture. It is selectively catheterized and angiographic films are taken. The catheter was then removed and a diagnostic guiding type, RDC catheter was used and the left renal artery was selectively engaged. A 0.014 Supracore wire was used and the lesion was crossed. A 6.0 X 18 mm balloon expandable Racer stent was introduced. This was expanded around 8 atmospheres of pressure which is nominal. Angiography revealed excellent results with no residual stenosis.  A. 36245-LT, 36251, 37236 D. 36245-LT, 37236

Accepted Answer

D. 36245-LT, 37236  Rationale: The left renal artery is a first order vessel as noted in Appendix L of the CPTÂ® codebook (36245-LT). The selective catheterization code is found in the CPTÂ® Index under Artery/Abdomen/Catheterization 36245-36248. Angiography of the left renal vessel was performed; however, there is no mention in the report of the results of the angiography. This is not a diagnostic angiography, rather it is angiography for mapping (checking out known stenosis). The stent was deployed (37236) in the left renal artery; this code also includes the radiologic supervision and interpretation. Code 37236 is found in the CPTÂ® Index under Stent/Placement/Transcatheter/Intravascular. Follow-up renal angiography is bundled with the stent procedure.

Question 30

A patient is brought to the operating suite when she experiences a large output of blood in her chest tubes post CABG. The physician performing the original CABG yesterday is concerned about the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he resutured.

Accepted Answer

D. 35820-78  Rationale: This is a postoperative exploration and modifier 78 is necessary because this is an unplanned return to the OR by the same physician during the global period of another procedure. Modifier 78 is used for a return to the OR for complications. This was an exploration for postoperative hemorrhage of the chest, 35820, which can be found in the CPTÂ® Index under Exploration/Blood Vessel/Chest, 35820.

Question 31

In the cardiac suite, an electrophysiologist performs an EP study. With programmed electrical stimulation, the heart is stimulated to induce arrhythmia. Observed is: right atrial and ventricular pacing, recording of the bundle of His, right atrial and ventricular recording, and left atrial and ventricular pacing and recording from the left atrium.

Accepted Answer

C. 93620, 93621, 93622  Rationale: The studies performed make up a comprehensive study (93620) which includes: evaluation with right atrial pacing and recording, right ventricular pacing and recording, and His bundle recording with induction of or attempted induction of arrhythmia. Left atrial pacing and recording (93621) and left ventricular pacing and recording (93622) are add-on codes. This is found in the CPTÂ® Index under Electrophysiology Procedure 93600-93660.

Question 32

MAZE procedure is performed on a patient with atrial fibrillation. The physician isolates and ablates the electric paths of the pulmonary veins in the left atrium, the right atrium, and the atrioventricular annulus while on cardiopulmonary bypass.

Accepted Answer

D. 33256   Rationale: The procedure described above is extensive according to CPTÂ® definition. Look in the CPTÂ® Index for Maze Procedure/Open, and you are referred to 33254-33256. The patient was on bypass; therefore, the correct code is 33256.

Question 33

A patient is seen to have an esophageal motility with acid perfusion study performed. What CPTÂ® code(s) is/are reported?

Accepted Answer

B. 91010, 91013  Rationale: This is a diagnostic gastrointestinal procedure. Look in the CPTÂ® Index for Gastroenterology, Diagnostic/Esophagus Tests/Motility Study directing us to codes 91010, 91013. 91010 best describes the motility study with add-on code 91013 used to identify the acid profusion study. Parenthetical note under add-on code 91013 indicates it is reported with code 91010.

Question 34

When reporting an encounter for screening of malignant neoplasms of the intestinal tract, what does the fifth character indicate?

Accepted Answer

A. Anatomic location being screened in the intestinal tract.  Rationale: Subcategory Z12.1 identifies screening for malignant neoplasms of the intestinal tract. The fifth character identifies the anatomic location in the intestinal tract.

Question 35

What is the eponym for a pancreatoduodenectomy?

Accepted Answer

A. Whipple Procedure  Rationale: A Whipple procedure is also known as a pancreatoduodenectomy. Look in the CPTÂ® Index for Whipple Procedure; it refers you to code 48150. The code description verifies that this procedures deals with a pancreatectomy and duodenectomy. The other eponyms can be found in the CPTÂ® Index, and do not involve the removal of the pancreas and duodenum.

Question 36

What is the term that describes the removal of a portion or all of the stomach?

Accepted Answer

C. Gastrectomy  Rationale: The prefix \"gastr-\" refers to the stomach and the suffix \"-ectomy\" indicates removal of.

Question 37

What parts make up the large intestine?

Accepted Answer

D. Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anus  Rationale: The large intestine consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and the anus.

Question 38

A patient is seen in the gastroenterologist\'s clinic for a diagnostic colonoscopy. When performing the service, the physician notes suspicious looking polyps and removes three of these to send to pathology for further testing using a snare technique. What is/are the correct CPTÂ® code(s) to report?  A. 45378, 45385-51 B. 45385

Accepted Answer

B. 45385  Rationale: A surgical endoscopy always includes a diagnostic endoscopy. Thus, code 45378 is not reported with code 45385. Reporting only 45385 is the correct code for the colonoscopy with removal of polyps, by snare technique. In the CPTÂ® Index, look for Colonoscopy/Proximal to Splenic Flexure/with Removal/Polyp directing you to 45384-45385.

Question 39

What CPTÂ® code(s) is/are reported for an endoscopic direct placement of a percutaneous gastrostomy tube for a patient who previously underwent a partial esophagectomy?

Accepted Answer

A. 43246  Rationale: Code 43246 represents the direct percutaneous placement of a gastrostomy tube. We do not code for the partial esophagectomy (43116) because it was not performed at this time but was done prior to the tube placement. The code is indexed in CPTÂ® under Endoscopy/Gastrointestinal/Upper/Tube Placement referring you to code 43246. There are a couple of other ways to find this in the Index. It helps to remember anatomy - the esophagus is part of the upper GI tract.

Question 40

45-year-old woman underwent a cholecystectomy performed laparoscopically. The procedure was performed for recurrent bouts of acute cholecystitis. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

B. 47562, K81.0  Rationale: 47562 is the code for a laparoscopic cholecystectomy. In the CPTÂ® Index, look for Cholecystectomy/Laparoscopic directing you to 47562. 47600 and 47605 are both open cholecystectomy codes. Acute cholecystitis is indexed in ICD-10-CM Index to Diseases and Injuries under Cholecystitis/acute for code K81.0

Question 41

40-year-old male patient is in the surgical suite to have an incarcerated hernia of his belly button repaired. What are the correct CPTÂ® and ICD-10-CM codes reported?

Accepted Answer

C. 49587, K42.0  Rationale: In the CPTÂ® Index look for Repair/Hernia/Umbilical/Incarcerated. This directs you to codes 49582, 49587 and 49653. Code 49587 represents this procedure is performed on a patient 5-years-old and above. Look in the ICD-10-CM Index to Diseases and Injuries for Hernia, hernia (acquired) (recurrent)/umbilicus, umbilical/with obstruction, directing you to K42.0. Verification of this code in the Tabular List, confirms code K42.0 represents an incarcerated umbilical hernia.

Question 42

What is the CPTÂ® code for a test used to diagnose carbohydrate malabsorption/carbohydrate intolerance or lactose intolerance? It involves the patient ingesting lactose or a carbohydrate feeding followed by collection(s) of exhaled air to measure the hydrogen in the breath.

Accepted Answer

C. 91065  Rationale: This scenario is describing a diagnostic GI study/test. This indicates we are performing the testing of breath hydrogen. In the CPTÂ® Index look for Gastroenterology, Diagnostic/Breath Test/Hydrogen, you are directed to code 91065. The code descriptor for 91065 indicates it is reported when determining lactose deficiency.

Question 43

A patient presents with a 2 cm benign lip lesion. The provider decides to remove the lesion with a portion of the lip by performing a wedge excision. Single-layer suture repair is performed. What CPTÂ® code(s) is/are reported for this service?

Accepted Answer

C. 40510  Rationale: Because the physician is not only removing the lesion, but also removing part of lip along with doing a repair, code 11422 is not reported. The lesion along with a portion of the lip is removed by a transverse wedge technique. Look in the CPTÂ® Index for Wedge Excision/Lip referring you to code 40510. The code description for code 40510 includes primary closure (suture repair), indicating the suture repair is included in code 40510 and therefore, an integumentary system repair code (12011) is not reported separately.

Question 44

If a perianal abscess is identified and incised and drained during the course of performing an internal or external hemorrhoidectomy, what CPTÂ® codes are reported?

Accepted Answer

A. 46255, 46050-51  Rationale: The hemorrhoidectomy is indexed in CPTÂ® under Hemorrhoidectomy/Simple referring you to code 46255. If you read all the code descriptions for hemorrhoidectomies, code 46255 is correct to report for the question since internal and external hemorrhoids were removed. The I;D code for the perianal abscess is indexed under Incision and Drainage/Abscess/Anal referring you to codes 46045-46050; code 46050 is the correct code to report.

Question 45

What is the correct ICD-10-CM coding for a 30-year-old obese patient with a BMI of 32.5?

Accepted Answer

B. E66.9, Z68.32  Rationale: Code E66.9 represents obesity, unspecified. In the ICD-10-CM Index to Diseases and Injuries, look for Obesity directing you to E66.9. In the Tabular List under category code E66 there is an instructional note to Use additional code to identify body mass index (BMI), if known (Z68.-).\" Code Z68.32 represents an adult BMI of 32.0-32.9.

Question 46

What is the correct CPTÂ® coding for a partial distal gastrectomy with Roux-en-Y reconstruction with vagotomy?

Accepted Answer

C. 43633, 43635  Rationale: In CPTÂ® Index look for Gastrectomy/Partial, which directs us to several codes including 43631-43635. When reviewing these codes in the main section of CPTÂ®, code 43633 code descriptor represents a partial gastrectomy with Roux-en-Y reconstruction. Code 43635 represents the vagotomy. Modifier 51 is not used, as code 43635 is an add-on code and is modifier 51 exempt.

Question 47

What is the correct coding for a physician who performs an UGI radiological evaluation of the esophagus, stomach and first portion of the duodenum with barium and double-contrast in the hospital GI lab? (Physician is not employed by the hospital)  B. 74246-26  D. 74249-26

Accepted Answer

B. 74246-26  Rationale: A radiological evaluation is an X-ray. UGI stands for Upper Gastrointestinal (GI). Look in the CPTÂ® Index for Gastrointestinal Tract/X-ray/with Contrast (for the double-contrast) we are directed to code 74246-74249. Code 74249 represents the same if done with small intestine follow through but here we only performed up to the first portion of duodenum. This is performed in the hospital using hospital equipment. The physician is not indicated to be an employee of the hospital so we must report for the professional services (component) only by appending modifier 26.

Question 48

11-year-old patient is seen in the OR for a secondary palatoplasty for complete unilateral cleft palate. Shortly after general anesthesia is administered, the patient begins to seize. The surgeon quickly terminates the surgery in order to stabilize the patient. What CPTÂ® and ICD-10-CM codes are reported for the surgeon?  A. 42220-53, Q35.9, R56.9 B. 42220-52, Q35.7, R56.9

Accepted Answer

A. 42220-53, Q35.9, R56.9  Rationale: In the CPTÂ® Index, look for Palatoplasty. Code 42220 represents a secondary repair to a cleft palate. Modifier 53 is appended because the procedure was terminated after anesthesia due to extenuating circumstances.   The diagnosis of a complete unilateral cleft palate is indexed in ICD-10-CM under Cleft/palate referring you to code Q35.9. Code R56.9 is reported because the patient began to seize after administering the general anesthesia. This is indexed in the ICD-10-CM under Seizure(s).

Question 49

Margaret has a cholecystoenterostomy with a Roux-en-Y. Five hours later, she has an enormous amount of pain, abdominal swelling and a spike in her temperature. She is returned to the OR for an exploratory laparotomy and subsequent removal of a sponge that remained behind from surgery earlier that day. The area had become inflamed and was demonstrating early signs of peritonitis. What is the correct coding for the subsequent services on this date of service? The same surgeon took her back to the OR as the one who performed the original operation. What CPTÂ® code is reported?

Accepted Answer

A. 49402-78  Rationale: CPTÂ® code 49402 represents the removal of a foreign body (sponge from previous surgery) from the peritoneal cavity. In the CPTÂ® Index, look for Removal/Foreign Body/Peritoneum. Modifier 78 indicates this was an unplanned return to the OR, by the same physician for a related procedure following an initial procedure during the initial procedures postoperative period.

Question 50

20-year-old patient presented to the hospital with a history of bloody stools for three weeks duration. The patient was prepped for a sigmoidoscopy. The sigmoidoscope was passed without difficulty to about 40 cm. The entire mucosal lining was erythematosus. There was no friability of the overlying mucosa and no bleeding noted anywhere. No pseudo polyps were noted. Biopsies were taken at about 30cm; these were thought to be representative of the mucosa in general. The scope was retracted; no other abnormalities were seen. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

A. 45331, K92.1  Rationale: CPTÂ® code for a sigmoidoscopy with single or multiple biopsies is reported 45331. This is indexed under Sigmoidoscopy/Biopsy. Diagnostic sigmoidoscopy is always bundled with a surgical sigmoidoscopy when both are performed in the same operative session.   The ICD-10-CM code for bloody stools is found in the Index to Diseases and Injuries under Blood/in/feces or Hematochezia or Melena and coded K92.1. When a patient comes in with a GI symptom (bloody stool, abdominal pain, etc.) and no definitive diagnosis is documented for the symptom(s), the symptom(s) will be reported.

Question 51

Surgical laparoscopy with a cholecystectomy and exploration of the common bile duct, for cholelithiasis. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

C. 47564, K80.20  Rationale: Code 47564 is accurate for laparoscopic cholecystectomy when the exploration of the common bile duct is also performed. In the CPTÂ® Index, look for Cholecystectomy/Laparoscopic directing you to 47562 - 47564.   We have a diagnosis of cholelithiasis but no mention of obstruction and not with cholecystitis, thus the correct ICD-10-CM code is K80.20. In the Index to Diseases and Injuries, look for Calculus, gallbladder, directing you to K80.20.

Question 52

A patient presents for esophageal dilation. The physician begins dilation by using a bougie. This attempt was unsuccessful. The physician then dilates the esophagus transendoscopically using a balloon (25mm). What CPTÂ® code(s) is/are reported?  A. 43450-53, 43220 B. 43220

Accepted Answer

B. 43220  Rationale: Because the esophageal dilation by using a bougie (43450) was unsuccessful, it is not reported. The esophagus was successfully dilated by performing transendoscopic balloon dilation (43220). This is the only code reported. In the CPTÂ® Index, look for Esophagus/Dilation/Endoscopic directing you to several codes.

Question 53

45-year-old patient with liver cancer is scheduled for a liver transplant. The patient\'s brother is a perfect match and will be donating a portion of his liver for a graft. Segments II and III will be taken from the brother and then the backbench reconstruction of the graft will be performed, both a venous and arterial anastomosis. The orthotopic allotransplantation will then be performed on the patient.  What CPTÂ® codes are reported?

Accepted Answer

C. 47140, 47146, 47147, 47135  Rationale: In the CPTÂ® Index, look for Hepatectomy/Partial/Donor or Transplant/Liver/Allograft/Preparation 47143 - 47147. Code 47140 represents the portion of the liver taken from the donor to be allotransplanted. Codes 47146 and 47147 represent the backbench work with venous and arterial anastomosis. We have a vein and an artery anastomosed so we only report each of these codes one time. The final code of 47135 represents the orthotopic allotransplantation into the patient; this is found in the CPTÂ® Index under Transplantation/Liver.

Question 54

How do you report a screening colonoscopy performed on a 65-year-old Medicare patient with a family history of colon cancer? The patient\'s 72-year-old brother was just diagnosed with colon cancer. The physician was able to pass the scope to the cecum. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

B. G0105, Z12.11, Z80.0  Rationale: For a Medicare patient, the preferred code to report a screening colonoscopy is HCPCS code G0105 Colonoscopy/cancer screening/ patient at high risk. In the ICD-10-CM Index to Diseases and Injuries look for Screening/colonoscopy leads to Z12.11. The patient is high risk due to a family history of colon cancer, which is reported with Z80.0. Look in the Index to Diseases and Injures for History/family (of)/malignant neoplasm/gastrointestinal tract.

Question 55

56-year-old patient complains of occasional rectal bleeding. His physician decides to perform a rigid proctosigmoidoscopy. During the procedure, two polyps are found in the rectum. The polyps are removed by a snare. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

D. 45315, K62.1  Rationale: CPTÂ® code 45315 is the correct code for the removal of more than one polyp by snare technique. In the CPTÂ® Index, look for Proctosigmoidoscopy/Removal/Polyp directing you to 45308-45315. During the proctosigmoidoscopy, polyps were removed by snare technique. The correct ICD-10-CM code is K62.1 because the polyps are located in the rectum. In the Index to Diseases and Injuries, look for Polyp, polypus/rectum directing you to K62.1. K63.5 is for polyps that are located in the large intestine.

Question 56

33-year-old male patient presents to the endoscopy suite to determine if he has an ulcer. The physician performs a diagnostic scope through the esophagus, stomach and into the duodenum and jejunum. During the scope the patient has a severe drop in blood pressure and the physician discontinues the procedure, but not before observing and diagnosing a bleeding ulcer on the stomach lining as well a perforated ulcer in the jejunum. A repeat examination is planned. What CPTÂ® and ICD-10-CM codes are reported?

Accepted Answer

C. 43235-53, K25.4, K28.5  Rationale: Code 43235 represents an Upper GI down into the small intestine or esophagogastroduodenoscopy. In the CPTÂ® Index, look for Endoscopy/Gastrointestinal/Upper/Exploration. We append modifier 53 since the procedure was terminated after anesthesia due to extenuating circumstances and a repeat examination is planned. In the ICD-10-CM Index to Diseases and Injuries, look for Ulcer/stomach/with/hemorrhage (K25.4). Next look for Ulcer/gastrojejunal/with/perforation directing you to K28.5. We code for the two ulcers found, K25.4 for the bleeding stomach ulcer and code K28.5 (unspecified as to acute or chronic) for the ulcer in the jejunum which is perforated.

Question 57

A patient with hypertension is scheduled for same day surgery for removal of her gallbladder due to chronic gallstones. She is examined preoperatively by her cardiologist to be cleared for surgery. What ICD-10-CM codes are reported by the cardiologist?  A. Z01.810, K80.20, I10 B. K80.20, I10, Z01.810

Accepted Answer

A. Z01.810, K80.20, I10  Rationale: In the Index to Diseases, look for Examination/preoperative - see Examination, pre-procedural. Look for Examination/pre-procedural/cardiovascular Z01.810. Next, in the Index to Diseases and Injuries, look for Calculus/gallbladder directing you to K80.20. Code I10 is for Hypertension. Correct codes and sequencing are Z01.810, K80.20 and I10. Sequencing of preoperative clearance first, next the reason for the surgery, last any other findings or diagnoses. Sequencing rule from Official Coding Guidelines of ICD-10-CM Section IV.M

Question 58

What ICD-10-CM code(s) is reported for ulcerative colitis with rectal bleeding?

Accepted Answer

C. K51.911  Rationale: Look in the ICD-10-CM Index to Diseases and Injuries for Colitis/ulcerative (chronic)/with complication/rectal bleeding directing you to K51.911. Verify the code in the Tabular List. This is a combination code that covers both the ulcerative colitis and rectal bleeding, you would not report an additional code for rectal bleeding.

Question 59

Where is the vermilion border located?

Accepted Answer

D. Upper lip  Rationale: The cutaneous portion of the upper lip extends from the bottom of the nose to the nasolabial folds laterally to the vermilion border or \"lipstick area\" of the lips. It is the red margin of the upper and lower lip.

Question 60

What is the CPTÂ® code for removal of a foreign body from the esophagus via the thoracic area?

Accepted Answer

C. 43045  Rationale: In the CPTÂ® Index, look for Esophagus/Removal/Foreign Bodies directing you to 43020, 43045, 43194, 43215, 74235. There are two open approaches and one endoscopic approach in the CPTÂ® codebook for the removal of a FB from the esophagus. 43020 is via a cervical approach and 43045 is via a thoracic approach. The note indicates this is \"via the thoracic area\" making code 43045 the correct choice.

Question 61

What ICD-10-CM code is reported for a patient with a family history of colon cancer?  A. Z85.038 D. Z80.0

Accepted Answer

D. Z80.0  Rationale: Family histories of a disease/condition are represented by Z codes. Look in the ICD-10-CM Alphabetic Index for History/family (of)/malignant neoplasm (of) NOS/ gastrointestinal tract referring you to code Z80.0. The Tabular List verifies code Z80.0 is reported for a family history of gastrointestinal tract malignancy.

Question 62

What are the CPTÂ® and ICD-10-CM codes for a hemicolectomy performed on a patient with colon cancer?

Accepted Answer

B. 44140, C18.9  Rationale: For the CPTÂ® code: hemi means half or partial and colectomy is the removal of the colon. Look in the CPTÂ® Index for Colectomy/Partial, which directs you to code 44140. Next, look in the ICD-10-CM Index to Diseases and Injuries for Carcinoma, which directs us to see also, Neoplasm, by site, malignant. Go to the Table of Neoplasms and look for Neoplasm, neoplastic/colon directs us to see also Neoplasm/intestine/large report code C18.9 under the Malignant Primary column. This is because there is no documentation that the cancer is secondary or had metastasized from another site it is considered primary. Verify the code in the Tabular List.

Question 63

12-year-old patient had an adenoidectomy in 2013 and a second adenoidectomy this year. What CPTÂ® code(s) is/are reported for the second adenoidectomy performed this year?

Accepted Answer

D. 42836  Rationale: Sometimes adenoid tissue, even after it has been removed, will grow back when a few cells are left in. For the removal of the secondary adenoid tissue, we report the secondary adenoidectomy represented by code 42836. Look in the CPTÂ® Index for Adenoids/Excision with a code range of 42830-42836. In this case, the patient would have been over 12 years of age upon presentation for the secondary adenoidectomy, further supporting the criteria for 42836.

Question 64

What is the correct ICD-10-CM code for a patient with IBS?

Accepted Answer

B. K58.9  Rationale: IBS stands for Irritable Bowel Syndrome. Look in the ICD-10-CM Index to Diseases and Injuries for Syndrome/irritable/bowel, which directs you to code K58.9. Verify the code in the Tabular List.

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